<p>This SHEA white paper identifies knowledge gaps and challenges in healthcare epidemiology research related to COVID-19 with a focus on core principles of healthcare epidemiology. These gaps, revealed during the worst phases of the COVID-19 pandemic, are described in 10 sections: epidemiology, outbreak investigation, surveillance, isolation precaution practices, personal protective equipment (PPE), environmental contamination and disinfection, drug and supply shortages, antimicrobial stewardship, healthcare personnel (HCP) occupational safety, and return to work policies. Each section highlights three critical healthcare epidemiology research questions with detailed description provided in supplemental materials. This research agenda calls for translational studies from laboratory-based basic science research to well-designed, large-scale studies and health outcomes research. Research gaps and challenges related to nursing homes and social disparities are included. Collaborations across various disciplines, expertise and across diverse geographic locations will be critical.</p>
<p>Antibiotic-resistant bacteria infect 2 million Americans annually, resulting in up to 100,000 deaths and excess healthcare costs exceeding $20 billion. Antibiotic use is a major contributor to antibitotic resistance, <em>Clostridioides difficile</em> infections (CDI), and antibiotic-associated adverse events. Antibiotics are frequently used across all healtcare settings in the United States, although much of this use is unnecessary. In response, antibiotic stewardship programs (ASPs) have sought to coordinate efforts to improve antibiotic prescribing. Although there has been much progress with antibiotic stewardship (AS) over the past decade, gaps in optimizing the reach and effectiveness of AS remain. We convened a diverse, multidisciplinary group of AS clinicians and researchers to delineate and prioritize these research gaps from a US human health perspective.</p>
<p>We highlight 4 broad categories in which gaps exist (Table 1): (1) a scientifically rigorous evidence base to define optimal antibiotic prescribing practices, which adequately inform AS interventions across a variety of patient populations and settings; (2) effective AS approaches to recognize effective interventions, knowledge of how these interventions can be adapted for implementation both locally and across diverse settings, and an understanding of how interventions can be sustained once implemented; (3) standardized process and outcome metrics; and (4) advanced study designs with appropriate analytic methods, accompanied by infrastructure to support data collection and sharing.</p>